Abstract
Treating the pain patient with chronic opioid therapy brings with it certain precautions and risks, with substance abuse and addiction being one of the most troublesome to clinicians. This risk is greatest for persons coming to chronic opioid therapy (COT) with a history of addictive disease; across a growing body of literature, a patient history of substance abuse or addiction is a primary predictor of problematic medication use in chronic pain treatment. This article reviews the key issues associated with COT in the substance abuser, beginning with the challenges associated with identifying addiction in the context of sanctioned opioid access, and complicated by the overlapping presentation of unrelieved pain and untreated addictive disease. Accepting the premise that chronic pain can only be successfully managed with COT if the patient is in recovery, the charge of the clinican becomes that of relaspe prevention. Strategies for preventing, identifying, and managing relapse in this uniquely vulnerable g...
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